Cervical Cancer - Introduction

The cervix is the lower portion of the uterus that connects the uterus to the vagina. The opening of the cervix remains small except during labor when it expands to allow the baby to pass from the uterus to the vagina. Cervical cancer occurs when cells in the cervix grow erratically and multiply out of control. As with other types of cancer, it often takes years for cervical cancer to develop. First, normal cervical cells change into pre-cancerous cells. Pre-cancerous abnormalities progress without symptoms and if left untreated, they eventually progress into cancer. When cervical abnormalities are detected and treated in pre-cancerous stages, cervical cancer is preventable.

Both pre-cancerous and cancer cells in the cervix can be detected with a Pap smear (also called Pap test). A Pap smear is a screening exam used to examine cells from the cervix and the vagina. If abnormal cells are found, they are classified according to their degree of abnormality.

Approximately 50 million Pap smears are performed each year in the United States. The increased use of Pap smear is largely responsible for a significant reduction in the number of deaths from cervical cancer over the years (a decrease of 74% from 1955 to 1992).

When detected early, the five-year survival rate for cervical cancer is approximately 92%. If cervical cancer is detected before it has invaded any surrounding tissues, the five-year survival rate is nearly 100%. Therefore, it is very important that all women begin receiving yearly Pap smears and pelvic examinations at age 18 or when they first become sexually active, whichever occurs earlier. Some physicians will not perform a Pap smear each year if a woman has had three negative (normal) Pap smears in the course of three years. However, a yearly pelvic exam should be continued even if Pap smears are not given each year.

Even with the increased use of the Pap smear, not all women receive yearly Pap smears. It is estimated that between 60% and 80% of American women who are newly diagnosed with cervical cancer have not had a Pap smear within the last five years, if ever. According to recent studies, elderly, African-American, and low-income women are the least likely to have annual Pap smears.

The American Cancer Society estimated that in 2004, 10,520 new cases of invasive cervical cancer would be diagnosed in the United States and approximately 3,900 American women would die from the disease. Researchers estimate that non-invasive cervical cancer is nearly four times as likely as invasive cervical cancer. The International Agency for Research on Cancer estimates that nearly 380,000 women are diagnosed with cervical cancer worldwide each year. The number of cases and number of deaths from cervical cancer are higher in less developed countries where routine screening is not widespread.

Source: J. Ferlay, F. Bray, P. Pisani and D.M. Parkin. GLOBOCAN 2000: Cancer Incidence, Mortality and Prevalence Worldwide, Version 1.0. IARC CancerBase No. 5. Lyon, IARCPress, 2001.

Risk factors for cervical cancer include age (the highest risk occurs between late teens and mid-thirties), early age at first sexual intercourse, multiple sexual partners, certain strains of the human papillomavirus (HPV, a sexually transmitted disease), smoking, and daughters of women who took DES (a hormonal drug prescribed between 1940 and 1971 to help prevent miscarriages). Because there are often no symptoms associated with early stages of cervical cancer, it is important that women receive annual Pap smears to screen for the disease. Symptoms that may be associated with cervical cancer include unusual vaginal discharge, vaginal bleeding, or bleeding or pain during sexual intercourse. In June 2006, the U.S. Food and Drug Administration approved a vaccine aimed at preventing cervical cancer and vulvar and vaginal pre-cancers. The vaccine, called Gardasil, had been shown to be effective at blocking cervical cancers caused by certain strains of HPV. To learn more about this vaccine, please visit FDA Advisory Panel Backs Cervical Cancer Vaccine

If Pap smear results suggest cervical cancer, a number of additional tests may be performed for confirmation, including colposcopy, cervical biopsy, or cone biopsy. Further imaging tests, such as CT scan or MRI may be performed if the cancer is suspected to have spread past the cervix to other areas of the body.

Treatment for cervical cancer depends on the stage of the cancer and other prognostic factors. The main types of treatment for cervical cancer include surgery (laser surgery, cone biopsy, hysterectomy) radiation therapy, and/or chemotherapy. The earlier cervical cancer is detected, the greater the chances for successful treatment and survival.

Cervical Cancer Topics:

• Risk Factors and Symptoms
• Pap Smear
• FDA Advisory Panel Backs Cervical Cancer Vaccine
• Diagnosis
• Stages of Cervical Cancer
• Treatment
• Additional Resources and References

Updated: June 1, 2008